- Dr Patrick McCarthy. Associate Professor Richard Matthews AM with Dr Patrick McCarthy, AGPT Registrar, Townsville

2016 HANDBOOK “ “Early on in medical school, I formed an impression of what it meant to be a certain type of doctor, whether it be a surgeon, physi...
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2016 HANDBOOK



“Early on in medical school, I formed an impression of what it meant to be a certain type of doctor, whether it be a surgeon, physician or paediatrician. These experiences and those formed whilst working guided my path into general practice. I think it was the diversity in general practice, allowing a doctor to mould their career around themselves that drew me to my career.

- Dr Patrick McCarthy Associate Professor Richard Matthews AM with Dr Patrick McCarthy, AGPT Registrar, Townsville.



When I consider my training last year sitting in registrar teaching, I was constantly reminded of the opportunities available, progressing alongside diverse practitioners with varied lifestyles from a mum training part-time to a defence registrar who had just returned from tsunami relief in the Phillippines.”

1 Australian General Practice Training Handbook 2016 Applications for the 2016 AGPT program open 13 April 2015

Acknowledgements:

The AGPT program is an Australian Government initiative

Published by:

Department of Health

Address:

Health Workforce Division

Scarborough House, Atlantic Street WODEN ACT 2606 Telephone:

1800 DR AGPT (37 2478) or for international callers: +61 2 6289 2666

Email: [email protected] Website: www.agpt.com.au © Department of Health 2015

Australian General Practice Training Handbook 2016

2

A Career in General Practice

There are many benefits when considering a career in general practice:

aried clinical work V Continuity of patient care • Dynamic, team-based medicine • Flexible working hours. More doctors are choosing general practice as a career for the many advantages it brings. General practice demands extensive medical knowledge and offers the opportunity to subspecialise and undertake procedural medicine. General practice allows for balance between work and family life, and the opportunity to be an integral part of a community. • •

GETTING STARTED

This Handbook provides an overview of the AGPT program, the opportunities available and the important role each organisation plays in providing every AGPT registrar with quality, well-supported training. To begin a career in general practice doctors need to: Check they meet the eligibility criteria Choose where they want to train

Apply online at www.agpt.com.au (applications open 13 April 2015)

Undertake national testing and assessment as part of the AGPT selection process. If accepted into the AGPT program:

Decide which college fellowship they wish to undertake (there are two colleges) Discuss with their training provider which practice they would like to train in

Set a personalised learning plan, with the help of their training provider, outlining interests and careers goals

Undertake training and college assessments to achieve fellowship and specialist (general practitioner) registration. Please note: The information in this Handbook is correct at the time of publication. Prospective applicants should regularly check the AGPT website (agpt.com.au) and read the 2016 AGPT Applicant Guide for updated information regarding eligibility, application requirements and any updates on training providers.

3

Contents 1. About the Australian General Practice Training Program 4 Training overview 4 Training delivery 5 Training eligibility 6 Diagram 1: General Practice Training Landscape 7 2. Training Qualifications 8 FACRRM/FRACGP 8 FARGP 8 Diagram 2: Australian General Practice Training 2015 10 3. Training Time Frames and Options Commencement of training Part-time training provision Leave from training Recognition of prior learning

11 11 11 11 11

4. Training Requirements General requirements Australian Defence Force doctors Rural generalist doctors

12 12 13 13

5. Training Pathways - General and Rural General pathway Rural pathway

14 14 15

6. Australian Standard Geographical Classification – Remoteness Area System 15 7. Training Providers 16 Diagram 3: Map of training providers 16 Training provider contacts 17 8. Extended Skills/Advanced Specialist Training Aboriginal and Torres Strait Islander health training Academic Posts

18 18 20

9. Remuneration and Incentives 22 Remuneration during training 22 Incentives 22 10. Application and Selection Process to Commence Training in 2016

25

11. Preparation for Application

27

Eligibility 27 Supporting documentation 27 Referees 27 Selecting a preferred training provider 27 National Testing and Assessment 28 Diagram 4: General/Rural Pathway Eligibility Guide AGPT 2016 32 Diagram 5: Program Eligibility Guide – AGPT 2016 Inside back cover

Australian General Practice Training Handbook 2016

4 IMPORTANT NOTICE:

Under the Commonwealth Budget 2014-15 General Practice Education and Training Limited (GPET) is one of the agencies to be closed at 31 December 2014. The company’s essential functions will be absorbed into the Department of Health from 1 January 2015. In 2015 the Department of Health will conduct a competitive tender process for the delivery of the 2016 AGPT program and future cohorts. This will likely result in a smaller number of training providers; a possible change in regional footprints; and, possibly, new providers taking on delivery of the program. It is not anticipated the change in providers will impact training places.

Doctors interested in applying for the 2016 AGPT program are encouraged to contact their current local training provider as normal. Training providers will continue to advise applicants on training options in the local region until such time as the tender process is complete.

Information regarding any changes to the AGPT program will be uploaded to the AGPT website (www.agpt.com.au) as it becomes available and potential applicants are advised to review it regularly to keep informed.

TRAINING OVERVIEW

General practice is a recognised medical specialty and a doctor must undertake vocational training to become a qualified specialist general practitioner in Australia. What is the Australian General Practice Training program?

The Australian General Practice Training (AGPT) program is a world-class vocational training program for medical graduates wishing to pursue a career in general practice in Australia. It is the leading training program for GP registrars in Australia. The program involves a three- or four-year full-time commitment, which may be reduced with recognition of prior learning (RPL) (see page 11). During training, registrars acquire valuable practical experience in different training locations, including teaching hospitals, rural and urban practices, and specialised medical centres that provide health care for Aboriginal and Torres Strait Islander peoples and people from socially disadvantaged groups. Registrars also acquire experience in extended skills/advanced specialised training, and can pursue other areas of relevant interest such as procedural general practice and academic posts. Training is conducted within accredited medical practices and hospitals and is supervised and assessed by accredited general practitioners. The training includes self-directed learning, regular face-to-face educational activities and in-practice education. Relevant college assessments are undertaken throughout or at the end of training to achieve fellowship and eligibility for specialist (general practitioner) registration.

A quota is placed on the number of AGPT positions available, therefore entry into the program is competitive. For the 2016 training year it is expected that 1500 training positions will be available within the AGPT program.

5 TRAINING DELIVERY

How does general practice training differ from other medical specialty training programs?

General practice training is funded by the Commonwealth and managed by the Department of Health, unlike other medical specialty training programs which are run by the relevant professional college/s.

Prior to 1 January 2015, the AGPT program was managed by General Practice Education and Training Limited (GPET). The Department of Health is now responsible for managing the delivery of the program through training providers. The Department of Health also manages the Overseas Trained Doctor National Education and Training (OTDNET) programme. For more information on OTDNET, please refer to agpt.com.au What role do the GP colleges play in the AGPT program?

There are two professional general practice colleges in Australia – the Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM). The two colleges are responsible for setting the curriculum and professional vocational training standards, assessment, certification and continuing professional development. The two colleges accredit training providers to deliver training in line with their curriculum and standards. The colleges award the two vocational end points of the AGPT program – Fellowship of RACGP (FRACGP) and Fellowship of ACRRM (FACRRM), both of which lead to specialist (general practitioner) registration with the Medical Board of Australia. (See ‘Training Qualifications’ on page 8 for further details.) What is a training provider?

Training providers are contracted by the Department of Health to provide registrars with the means to undertake the AGPT program. Training providers, together with the two colleges, are responsible for accrediting hospital posts, general practices and other medical facilities for the delivery of vocational training; and placing registrars with these facilities to undertake their training. Training providers also provide:

A personalised support and learning program Education and training events and activities Networking opportunities Facilities and access to resources Advice and support relating to the AGPT program and policy changes. When applying for the AGPT program, applicants must consider their preferences for where they undertake their training and the services available in each state/territory. Applicants are encouraged to contact the training providers in the regions in which they are interested in training to assist in this decision making process (see page 17 for a list of training providers).

• • • • •

Please note: The list of training providers is current until 31 December 2015. A competitive tender process will be undertaken during 2015 for the delivery of the 2016 AGPT program and future cohorts. This will likely result in a smaller number of training providers; a possible change in regional footprints; and, possibly, new providers taking on delivery of the program. It is not anticipated the change in providers will impact training places. Although transfers are available in some circumstances, registrars are required to remain with their selected training provider for the entirety of the training program. For further information regarding transfers, please read the Transfer Policy 2015 at www.agpt.com.au in the ’About Us’ section.

Australian General Practice Training Handbook 2016

6 TRAINING ELIGIBILITY

When can doctors apply for the AGPT program?

Doctors can apply for the AGPT program as early as their intern year, to begin training the following year. How can a doctor determine if they are eligible to apply?

To self-assess eligibility to join the AGPT program, check the Program Eligibility Guide – AGPT 2016 inside the back cover fold out.

Doctors who are eligible for the program and are overseas-trained (also known as OTDs) or foreign graduates of an accredited medical school (FGAMS) will need to check their pathway eligibility and whether or not they are subject to section 19AB of the Health Insurance Act 1973.

Doctors can self-assess their pathway eligibility using the General/Rural Pathway Eligibility Guide – AGPT 2016 inside the back cover. Doctors applying for the AGPT program must nominate to train on either the general or rural pathway. However, doctors who are subject to section 19AB can only train on the rural pathway (see page 14). What is section 19AB of the Health Insurance Act 1973?

Section 19AB of the Health Insurance Act 1973, prescribes a 10-year moratorium for some doctors seeking to practice in Australia. This is an Australian Government policy which restricts access to Medicare benefits and requires OTDs and FGAMS to work in a district of workforce shortage for 10 years in order to access Medicare arrangements.

Section 19AB applies for a period of 10 years (and may be scaled to five years depending on remoteness) starting from the date a doctor first gains medical registration in Australia, which includes provisional or limited registration. For more information visit www.doctorconnect.gov.au go to ‘First steps’ and click ‘Medicare provider number legislation’ or contact the Department of Health at [email protected]

7

DIAGRAM 1:

GENERAL PRACTICE TRAINING LANDSCAPE

Australian Government

Australian General Practice Training program

Training Providers Vocational Training

Fellowship of the Australian College of Rural and Remote Medicine (FACRRM)

Fellowship of the Royal Australian College of General Practitioners (FRACGP)

Specialist (General Practitioner) Registration

Australian General Practice Training Handbook 2016

8

Training Qualifications

The AGPT program supports three fellowships, outlined below, two of which (FACRRM and FRACGP) lead to specialist (general practitioner) registration. Registrars may choose which fellowship/s they would like to pursue.

FACRRM/FRACGP

The AGPT program is primarily designed to prepare registrars to undertake the Fellowship of the Australian College of Rural and Remote Medicine (FACRRM) and/or the Fellowship of the Royal Australian College of General Practitioners (FRACGP). The FACRRM with its broader curriculum and scope of practice is specifically designed to prepare registrars to practise competently and confidently in rural and remote medicine, often in locations of relative professional isolation. Registrars undertake the majority of their training in rural and remote settings and are able to complete their assessments at these locations. The FRACGP curriculum is designed to prepare registrars to competently deliver unsupervised general practice services in any urban, regional, rural or remote general practice setting.

Both fellowships lead to specialist (general practitioner) registration and the ability to work independently as a GP anywhere in Australia. Prerequisites for the FACRRM and FRACGP are:

Satisfactorily completing the required period of training, three years of training for the FRACGP and four years for the FACRRM (see Diagram 2: Australian General Practice Training 2016, page 10) • Satisfactorily meeting the education requirements of training • Passing the ACRRM or RACGP assessments. For further information on the FACRRM or FRACGP visit the college websites: •

ACRRM: www.acrrm.org.au select ‘Programs’ > ‘Vocational Training’ > ‘Training towards fellowship of ACRRM’ RACGP: www.racgp.org.au select ‘Becoming a GP’ > ‘Vocational Training Pathway’

Deciding which fellowship to undertake is a personal decision. The Department of Health recommends that doctors considering applying for the AGPT program contact both colleges, as well as their preferred training provider, to discuss options and determine the best fit for their learning style, career goals and the skill set they wish to attain. Dual Fellowship

Registrars are able to undertake dual fellowships with both RACGP and ACRRM. The training must be concurrent and should only be pursued after discussions with a registrar’s training provider. For further information potential applicants should contact their preferred training provider (see page 17 for list of training providers).

FARGP

Training providers also support training towards the Fellowship in Advanced Rural General Practice (FARGP). The FARGP is a qualification awarded by the RACGP in addition to the vocational Fellowship (FRACGP), the FARGP cannot be undertaken as a stand-alone general practice qualification.

9 The FARGP has a distinct pathway for general practice registrars who wish to develop advanced rural skills and broaden options for safe, accessible and comprehensive care for Australia’s rural, remote and very remote communities. For more information on the FARGP please email [email protected] or call the RACGP National Rural Faculty on 1800 636 764.

Australian General Practice Training Handbook 2016

10

tralian General Training DIAGRAM 2: AUSTRALIANPractice GENERAL PRACTICE TRAINING 2016 Progr

Year One

FACRRM QUALIFICATION (ACRRM)

FRACGP QUALIFICATION (RACGP)

Core Clinical Training Time

Hospital Training Time

+

+

12 months

12 months

GP Terms

Year Two

GPT 1 – 6 Primary Rural & Remote Training

+

24 months

GPT 2 – 6

months months

+ GPT 3

6 months

Year Three

Extended Skills

6 months

+

Year Four

Note: Fourth year is for FACRRM & FARGP candidates

Advanced Specialised Training

FRACGP*

12 months

Advanced Rural Skills Training (12 months) for FARGP

FACRRM*

FARGP

There are instances where training time and experience for one fellow may be recognised towards or where subsequent Please refer to the relevantmay college There areanother instances trainingfellowship. time and experience for one fellowship be or training providers. recognised towards another or subsequent fellowship. Please refer to the relevant

*Leading specialist (general practice) registration. college or to RTP. *Leading to specialist (general practice) registration

11

Training Time Frames and Options

The AGPT program generally takes three to four years to complete, depending on which fellowship a registrar wishes to obtain. Training time can be reduced through a successful application of recognition of prior learning (RPL) see below. FACRRM requires a four year full-time or equivalent training commitment FRACGP requires a three year full-time or equivalent training commitment • FARGP requires a one year full-time or equivalent commitment additional to the three year training requirement for FRACGP. All policies below are available on the AGPT website (www.agpt.com.au) in the ‘About Us’ section. • •

COMMENCEMENT OF TRAINING

The AGPT program begins in January or February each year; start dates are determined by the individual training providers. There are limited circumstances where a registrar can defer commencement of training; these exceptional circumstances are detailed in the Leave From Program Policy 2015.

PART-TIME TRAINING PROVISION

Doctors are accepted into the AGPT program as full-time registrars. Registrars can apply to their training provider to undertake all or part of their training on a part-time basis. Although the hospital year is normally undertaken full-time, all other components of AGPT may be undertaken on a part-time basis, subject to approval by a registrar’s training provider and the Department of Health. For further information see the Training Time Policy 2015.

LEAVE FROM TRAINING

Leave from the program is restricted and subject to training provider approval. Potential applicants are encouraged to read the Leave From Program Policy 2015 and consider the restrictions that apply.

RECOGNITION OF PRIOR LEARNING

Recognition of prior learning (RPL) can reduce a registrar’s overall time in the AGPT program. RPL applications are assessed and approved by the relevant college censors (ACRRM/ RACGP) not the Department of Health. Training providers will generally assist registrars to complete their RPL applications.

Applications for RPL should be made in the first year of the AGPT program, not prior, and submitted by the registrar’s training provider to the relevant college censors for assessment.

For queries regarding FACRRM related RPL please email [email protected] or call 1800 223 226 (Int: +61 7 3105 8200)

For queries regarding FRACGP related RPL please email [email protected] or call 1800 626 901 (Int: +61 3 8699 0454)

Australian General Practice Training Handbook 2016

12

Training Requirements GENERAL REQUIREMENTS

Training generally commences at the beginning of the calendar year. Prospective applicants are advised to contact their preferred training provider for advice about potential placements for 2016, particularly if they wish to commence training in general practice placements. AGPT registrars are required to participate in a range of educational activities and will regularly receive feedback on their progress.

More information about the training requirements and curriculum of both colleges is available on their respective websites at www.acrrm.org.au and www.racgp.org.au Mandatory Hospital Rotations

Certain hospital rotations must be completed by doctors in their PGY1 and 2 years, or later. These mandatory hospital rotations do not have to be completed before application and entry into the AGPT program.

Where possible all rotations should be completed prior to the second year of the AGPT program when registrars begin working in the general practice setting (see ‘Primary Rural and Remote Training/GP Terms’ Australian General Practice Training 2016).

The following is a guide to the rotations required.

PGY 1 – Rotations required to achieve general registration • • •

Medicine Surgery Emergency

PGY 2 or later – Rotations required by the colleges as part of the college fellowship requirements RACGP Paediatrics Three rotations of choice relevant to general practice

• •

ACRRM

• • •

Paediatrics Obstetrics and gynaecology Anaesthetics

Prospective applicants should refer to the relevant college documents below and discuss with their preferred training provider for more detailed information: • •

ACRRM – Core Clinical Training Policy at https://www.acrrm.org.au/operational-policies RACGP – General Practice: A guide for students and junior doctors at http://www.racgp.org.au/becomingagp/students/

Please note: If a rotation is not completed, please contact your preferred training provider or the relevant college for further information on various alternatives to gain these skill sets as you progress through training. Contact:

ACRRM RACGP Phone: 1800 223 226 (Int: +61 7 3105 8200)

Email: [email protected] Website: www.acrrm.org.au

Phone: 1800 626 901 (Int: +61 3 8699 0454)

Email: [email protected] Website: www.racgp.org.au

13 AUSTRALIAN DEFENCE FORCE DOCTORS

All training providers can accommodate Australian Defence Force (ADF) doctors.

ADF doctors apply for the AGPT program in the same way as non-ADF doctors and are required to meet the same general educational requirements as other AGPT registrars once enrolled in training. ADF registrars are required to undertake a period of full-time civilian general practice training. Other training can be undertaken in a combination of civilian and military posts.

ADF doctors applying for the AGPT program are encouraged to speak to their preferred training provider to discuss training options. Because of the service demands on ADF registrars, it is recommended that where possible they undertake a full-time, civilian core general practice or primary rural and remote training unit (see Diagram 2: Australian General Practice Training 2016 page 10) during their post-intern year. Ideally, to meet the general service requirements placed on ADF registrars, this unit would be undertaken in a rural setting to provide the registrar with more exposure to the differing responsibilities rural general practice and/or rural and remote medicine entails, including: Decision-making Leadership • Autonomy • Teamwork • Coordination skills • Procedural skills. For more information regarding general practice in the ADF see Australian Defence Force Policy 2016 at agpt.com.au in the ‘About Us’ section or contact: • •

Medical Officer Career and Professional Development Committee (MOPCDC) Secretariat Joint Health Command

CP3-6-162, Campbell Park Offices PO Box 7912

CANBERRA BC, ACT 2610

E: [email protected]

RURAL GENERALIST DOCTORS

Doctors enrolled in a state or territory rural generalist program at the time of application to the AGPT program are required to apply for the AGPT program in the same way as non-rural generalist doctors and must select the rural pathway (see page 15) in their online application. AGPT training positions are not guaranteed for rural generalist doctors. If successful in obtaining a place in the AGPT program rural generalist doctors are required to meet the same education and training requirements as other AGPT registrars. For information about the rural generalist program please contact your relevant state or territory health department or employer.

Australian General Practice Training Handbook 2016

14

Training Pathways – General and Rural

Doctors applying for the AGPT program elect to train on either the rural pathway or the general pathway. These pathways determine the area where a registrar will train, not the content of their general practice training. Most training providers offer both general and rural pathways with no difference in the training given to either group. However, rural pathway registrars have some restrictions as to where they can be placed during their training. The pathway system ensures at least fifty per cent of the AGPT program is delivered in rural and remote areas, to meet community need. The Australian Standard Geographical Classification – Remoteness Areas (ASGC-RA) system determines what constitutes urban, regional, rural and remote areas (see page 15).

A registrar’s training pathway has no implications on where they can later work as a fellowed GP with specialist (general practitioner) registration. Training locations, distribution of training placements and registrar allocation to those placements across a training provider region is managed by the training provider. This ensures appropriate workforce outcomes are achieved.

GENERAL PATHWAY

The general pathway is for doctors who wish to train primarily in urban areas. However, such a choice does not preclude a change in career direction, which has often occurred after registrars have worked in and enjoyed general practice in rural areas. Doctors on the general pathway can train in all Australian Standard Geographical Classification – Remoteness Areas (RA) 1-5 locations (see page 15). General pathway registrars are required to fulfil a 12-month general pathway training obligation as part of their training. This is done by electing one of the following options: 1.

12-months training in a rural location classified as RA2-5

3.

12-months training in a non-capital city classified as RA1

2.

12-months training in an outer metropolitan location

Or 4.

12-months training comprising two of the following: • • • •

Six-months training in a rural location classified as RA2-5 Six-months training in an outer metropolitan location Six-months training in a non-capital city location classified as RA1 Six-months training in an Aboriginal and Torres Strait Islander health training post in an Aboriginal Community Controlled Health Service (ACCHS).

15 RURAL PATHWAY

The rural pathway is for doctors who wish to undertake the majority of their training in regional, rural and remote areas of Australia. Doctors who elect the rural pathway are required to undertake their training in rural locations classified as RA2-5 (see below). The rural pathway offers a range of benefits and opportunities commensurate with the work of rural general practice for example, access to procedural training. Doctors undertaking the rural pathway can pursue FRACGP and/or FACRRM training. Overseas-trained doctors (OTDs) and foreign graduates of an accredited medical school (FGAMS) who are subject to section 19AB of the Health Insurance Act 1973 (the 10-year moratorium) must train on the rural pathway and are ineligible for the general pathway. For more information visit www.doctorconnect.gov.au go to ‘First steps’ and click on ‘Medicare provider number legislation’ or contact [email protected].

Australian Standard Geographical Classification – Remoteness Areas (ASGC-RA) System

The Australian Standard Geographical Classification – Remoteness Area (ASGC-RA) system was introduced on 1 July 2010. The ASGC-RA has been developed by the Australian Bureau of Statistics using 2006 census data and is widely used by Commonwealth and state agencies. The ASGC-RA divides regions that share remoteness characteristics into RA groups. RA-1 is major cities and can be defined as urban locations; RAs 2-5 are grouped in progressively more remote locations, and can be defined as regional or remote. Registrars on the general pathway may train in RA1-5 locations. Registrars on the rural pathway must train in RA2-5 locations. RA 1

Major cities of Australia

RA 2

Inner regional Australia

RA 3

Outer regional Australia

RA 4

Remote Australia

RA 5

Very remote Australia

For more information about ASGC-RA please go to: http://www.doctorconnect.gov.au/internet/otd/Publishing.nsf/Content/RA-intro. Please note: The ASGC-RA system is under review. If there are changes to the system which impact on AGPT program registrars, then information will be provided on the DoctorConnect and AGPT websites.

Australian General Practice Training Handbook 2016

16

Training Providers

DIAGRAM 3: MAP OF TRAINING PROVIDERS

The Department of Health contracts with training providers across Australia. Each training provider is responsible for managing registrars’ training, training locations and the distribution of training placements across their region.

Northern Territory GP Education

Tropical Medical Training

WAGPET Adelaide to Outback GP Training

Queensland Rural Medical Education PLUS General Practice Training Queensland

General Practice Training Queensland North Coast GP Training GP Synergy New England/Northwest

Beyond Medical Education

GP Training Valley to Coast GP Synergy - Sydney Central and South/Southwest

WAGPET Sturt Fleurieu Education and Training

WentWest

Bogong

CoastCityCountry General Practice Training

GP Training Tasmania

Shared zone: Sturt Fleurieu and Southern GP Training Southern GP Training

Shared/transitional zone

Victorian Metropolitan Alliance Shared zone: Southern GP Training and Victorian Metropolitan Alliance

Please note: These training providers are current until 31 December 2015. A competitive tender process will be undertaken during 2015 for the delivery of the 2016 AGPT program and future cohorts. This will likely result in a smaller number of training providers; a possible change in regional footprints; and, possibly, new providers taking on delivery of the program. It is not anticipated the change in providers will impact training places. Some areas of Australia are designated ‘shared’ or ‘transitional’ zones. These areas are currently shared by or in transition between training providers. For further information on training in these areas please contact the relevant training providers directly.

17 Training Provider Contacts Australian Capital Territory /New South Wales

South Australia

Beyond Medical Education (NSW and Victoria) W: www.beyondmedical.com.au T: (02) 6334 4359 or (03) 5441 9300 E: [email protected]

Adelaide to Outback GP Training Program W: www.adelaidetooutback.com.au T: (08) 8366 3100 E: [email protected]

Bogong Regional Training Network (NSW and Victoria) W: www.bogong.org.au T: (02) 6057 8600 E: [email protected]

Southern GP Training W: www.southerngptraining.com.au T: (03) 5132 3100 or (03) 5562 0051 E: [email protected] or [email protected]

Coast City Country General Practice Training (ACT and NSW) W: www.ccctraining.org T: (02) 6923 5400 E: [email protected] General Practice Training Valley to Coast (NSW) W: www.gptvtc.com.au T: (02) 4968 6753 E: [email protected] GP Synergy (Sydney and northern NSW) W: www.gpsynergy.com.au T: (02) 9818 4433 E: [email protected] North Coast GP Training (northern NSW) W: www.ncgpt.org.au T: (02) 6681 5711 E: [email protected]

Sturt Fleurieu Education and Training W: www.sfet.com.au T: (08) 8172 7600 E: [email protected]

Tasmania General Practice Training Tasmania W: www.gptt.com.au T: (03) 6215 5000 E: [email protected]

Victoria Beyond Medical Education (Victoria and NSW) W: www.beyondmedical.com.au T: (03) 5441 9300 or (02) 6334 4359 E: [email protected]

WentWest (western Sydney) W: www.wentwest.com.au T: (02) 8811 7100 E: [email protected]

Bogong Regional Training Network (Victoria and NSW) W: www.bogong.org.au T: (02) 6057 8600 E: [email protected]

Northern Territory

Southern GP Training W: www.southerngptraining.com.au T: (03) 5132 3100 or (03) 5562 0051 E: [email protected] or [email protected]

Northern Territory General Practice Education Ltd W: www.ntgpe.org T: (08) 8946 7079 E: [email protected]

Queensland General Practice Training Queensland* W: www.gptq.qld.edu.au T: (07) 3552 8100 E: [email protected]

Victorian Metropolitan Alliance W: www.vma.com.au T: (03) 9822 1100 E: [email protected]

Western Australia

Queensland Rural Medical Education W: www.qrme.org.au T: (07) 4638 7999 or (07) 4151 4777

Western Australian General Practice Education and Training W: www.wagpet.com.au T: (08) 9473 8200 E: [email protected]

Tropical Medical Training W: www.tmt.org.au T: (07) 4729 5000

*Formerly Central and Southern Queensland Training Consortium (CSQTC)

Australian General Practice Training Handbook 2016

18

Extended Skills/Advanced Specialised Training A set period of skills training is required by both RACGP and ACRRM for registrars undertaking vocational training through the AGPT program. Skills training is generally undertaken as an extended skill and/or advanced specialised training term.

The following is a list of just some of the skills training options available to AGPT registrars, subject to availability: • • • • • • •

Aboriginal and Torres Strait Islander health Academic general practice Anaesthetics Palliative care Mental health Dermatology Sports Medicine.

For a full list of skills training options and requirements for each college fellowship visit the ACRRM and RACGP websites and speak to your preferred training provider.

ABORIGINAL AND TORRES STRAIT ISLANDER HEALTH TRAINING Aboriginal and Torres Strait Islander health is an important aspect of general practice training. The Department of Health, together with the training providers and colleges, works in consultation with the ACCHS sector to contribute to the Council of Australian Government’s ‘Closing the Gap’ initiatives.

All AGPT registrars must meet the requirements of the Aboriginal Health Curriculum Statement (contained in the ACRRM and RACGP curricula) to complete the AGPT program. However AGPT registrars are encouraged and supported to undertake further dedicated training in this area. Registrars can choose to undertake an AGPT accredited Aboriginal and Torres Strait Islander health training post at any time during their training, after the initial hospital year. These posts are located in Aboriginal community controlled health services and state and territory government health services, in metropolitan, rural and remote areas. Benefits of an Aboriginal and Torres Strait Islander health training post • •

• • •

The opportunity to experience a unique training environment within the context of comprehensive holistic primary health care Gain ‘real world’ clinical experiences by treating Aboriginal and Torres Strait Islander patients presenting significant common and uncommon conditions which exemplify general practice Work towards becoming a clinically and culturally competent GP Experience a unique cultural immersion Focus on population-based public health.

To find out more about these posts visit the ‘Aboriginal and Torres Strait Islander health’ section of the AGPT website (www.agpt.com.au) or speak to a training provider (see page 17).

19 “I’ve had the chance to work with the RFDS providing health care to Aboriginal Communities in outback South Australia. I was the only female doctor in the group of RFDS doctors which was a gap in the service I was able to help with. I was known as the kunga (a Pitjantjatjara word for girl/female). It used to make me laugh, I’d hear the AHWs or clinic nurses asking patients if they wanted to see Dr so-and-so, or the kunga.” Dr Crystal Pidgeon, AGPT registrar, Beaudesert.

Australian General Practice Training Handbook 2016

20 ACADEMIC POSTS

The everyday practice of GPs is based on evidence. GPs and GP registrars need to be able to filter, critically appraise, interpret and apply the myriad of information available to them. The AGPT program appreciates this need and seeks to up-skill registrars in the areas of research and critical thinking. The AGPT program offers the opportunity to undertake salaried training for a period of 12 months part-time, in an academic post.

During an academic post, AGPT registrars develop skills in research, teaching, project work and critical evaluation of research relevant to the discipline of general practice. These skills will be of use throughout their careers and will contribute to knowledge exchange and development. Some examples of previous academic post projects include: • •

• • •

Transient Ischaemic Attacks in Community Settings: consultation patterns, risk factor recognition and management in twelve-months prior to TIA and minor stroke Cochrane Systematic Review: What is the impact of psychological interventions delivered within the health setting upon the quality of life and mental health of female victims of intimate partner violence? Introduction of meningitis B vaccine into primary healthcare - a survey of knowledge, attitudes and factors affecting immunisation practices among South Australian GPs Cross cultural training of GP registrars - Who is responsible? Assessing the perceptions and training needs of GP Supervisors in Western Sydney What factors influence the provision of Intra-Uterine Devices (IUDs) for contraception, in a rural area?

Academic posts offer the opportunity to: • • • • •

Contribute to the evidence on which general practice is based Acquire quality, supported experience in research and teaching Attend funded workshops and conferences Publish work in professional journals and present at conferences Help build the foundation to become a GP academic supervising university research, become a medical educator, or undertake a PhD.

To find out more about academic general practice visit the ‘Academic Training’ pages of the AGPT website at www.agpt.com.au under GP registrars.

21 “I wanted to do an academic post because I had never tried research before and wanted to give it a go in a supported environment. I was fortunate enough to find a department and supervisor who would support my area of interest – youth health – so this was very encouraging. The academic post was a great way to break up the week so that I was regularly doing something new and learning new skills. I felt refreshed starting a day in clinic and refreshed again starting a day in Uni.” Dr Deepthi Iyer, AGPT Registrar and 2013 AGPT Registrar Research and Development Officer (RRADO)

Australian General Practice Training Handbook 2016

22

Remuneration and Incentives

TERMS AND CONDITIONS OF EMPLOYMENT DURING GP TRAINING During the first year of hospital-based training within the AGPT program, registrars are paid through the relevant state or territory health department according to the appropriate awards for junior medical officers.

During the following two years of community-based training, registrars are employed by accredited training practices. The terms and conditions of employment are outlined in a document entitled National Terms and Conditions for the Employment of Registrars (NTCER). The NTCER represents an agreement between General Practice Registrars Australia (GPRA) and General Practice Supervisors Australia (GPSA), with the support of the Australian Medical Association (AMA). The agreement is regularly reviewed to maintain contemporary employment terms and conditions. Prospective registrars are encouraged to access the document on either the GPRA website at www.gpra.org.au/termsandconditions or the GPSA website at www.gpsupervisorsaustralia.org.au/ntc/. The Employment Agreement template is downloadable from the GPRA and GPSA websites.

Registrars seeking assistance regarding employment arrangements can seek advice from registrar liaison officers, their training provider or GPRA before approaching practices. Registrars are also encouraged to discuss with their training provider the opportunities available to work in a range of organisation and business types, including in regional and rural/remote Australia, during their two years of community based training.

The Department of Health is unable to provide further advice on training remuneration, terms and conditions; further questions should be directed toward preferred training providers and/ or GPRA.

INCENTIVES

The following incentives promote careers in outer metropolitan, rural and remote areas. General Practice Rural Incentives Programme (GPRIP)

AGPT registrars may be eligible for payments under the General Practice Rural Incentives Programme (GPRIP).

For more information about the GPRIP call the Medicare Australia Helpline: 1800 010 550 or visit the Rural and Regional Health Australia website at www.ruralhealthaustralia.gov.au go to ‘RHWS Incentives’ and click on ‘The programs’. HECS Reimbursement Scheme

Participants in the HECS Reimbursement Scheme are able to apply to have their HECS fees, for the study of medicine, reimbursed for each year of training undertaken or service provided in designated rural and remote areas of Australia. Eligible areas are RA 2-5 locations as defined under the Australian Standard Geographical Classification – Remoteness Area (see page 15). Payments to eligible participants will be scaled by remoteness according to the RA classification of the locality they are training or providing services in.

23 The following is a guide to the HECS Reimbursement Scheme. ASGC-RA

No. of years to receive full reimbursement entitlement

RA 3 - Outer regional Australia

4 years

RA 2 - Inner regional Australia RA 4 - Remote Australia

RA 5 - Very remote Australia

5 years

3 years 2 years

Please note: Some recipients of scholarships may be ineligible for the HECS Reimbursement Scheme.

Application forms and guidelines can be obtained from the HECS Reimbursement Scheme webpage at www.health.gov.au/hecs or by calling Medicare on 1800 010 550. Other grants or incentive programmes

Other grants or incentive programmes may be available to registrars via the colleges, for more information visit www.acrrm.org.au and/or www.racgp.org.au

Australian General Practice Training Handbook 2016

24 “I arrive at work and don’t know what the day will hold - and that’s what I love about going to work… I fell into general practice because I like all parts of medicine and in general practice I get to practice all forms of medicine, acute and preventative; medical and surgical. Whilst I may not know what patient or problem will walk through my door, I do know that I have an amazing support system in the form of my GP supervisors and other practice staff who help me manage sometimes really tricky patients and diagnostic dilemmas.” Dr Amanda Wijeratne, AGPT Registrar Port Macquarie

25 Application and Selection Process to Commence Training in 2016

Applications for the 2016 AGPT program will open on Monday 13 April 2015 and close on Friday 8 May 2015.

Below is a summary of the 2016 AGPT program application and selection process and some useful tips to help applicants prepare.

Please note this is only a guide and it is recommended that applicants refer to the AGPT website or the 2016 AGPT Applicant Guide (available at www.agpt.com.au) for the most up to date information. The AGPT application and selection process is made up of three stages.

Stage

1

if elibigle

Application and eligibility check Applicants submit an online application, supporting documentation, referee details and up to four preferences for the training providers they would like to train with. Applications and supporting documents will be checked to establish eligibility for the AGPT program. Applicants who are ineligible will be notified by email.

National assessment Applicants will be emailed and requested to attend two assessments at two different venues: 1. An online Situation Judgement Test (SJT) held at a National Testing Centre (NTC) from 15 June to 6 July 2015

Stage

2

2. Face-to-face Multi Mini Interviews (MMIs) held at a National Assessment Centre (NAC) from 26 June to 19 July 2015. Please note: NTC and NAC dates vary by city, please check the AGPT website for details. The standardised results of these assessments will determine applicants’ total AGPT selection scores. After receiving their total AGPT selection score applicants will have the option to change their training provider preferences. Depending on their total AGPT selection score and training provider preferences it will be established whether they can be shortlisted to a training provider. Applicants will be notified of the outcome by email.

If shortlisted

Stage

3

Training provider selection and placement offers The training provider will examine shortlisted applications. They may ask applicants for additional information, an interview, or make a decision based on the total AGPT selection score. The training provider will decide which applicants will be offered training places in the 2016 AGPT program, and will notify applicants. Written acceptance of a training provider’s offer of an AGPT training place, within seven days of the offer being made, will confirm selection into the 2016 AGPT program.

Australian General Practice Training Handbook 2016

26 This three-stage process will run from the opening of applications in April through to September 2015 when applicants will be informed as to whether or not they have been offered a place in the 2016 AGPT program.

All applicants are strongly encouraged to read the 2016 AGPT Applicant Guide for detailed instructions on how to fill out the online application form and an overview of the selection process.

27

Preparation for Application

There are a number of things applicants can do to prepare for application:

ELIGIBILITY

Potential applicants should self-assess their eligibility to join the AGPT program using the Program Eligibility Guide – AGPT 2016 inside the back cover fold out.

If eligible, doctors who are OTDs or FGAMS should then check their pathway eligibility using the General/Rural Pathway Eligibility Guide – AGPT 2016 inside the cover; to determine which pathway they can apply for – general or rural.

SUPPORTING DOCUMENTATION

Applicants are required to electronically upload original, colour scans of various official documents (for example, residency/citizenship proof) with their online application in order to meet a number of eligibility requirements. Should the AGPT Selection team have any doubts as to the validity of the document/s, they reserve the right to request certified copies of any or all supporting documents required. Applicants unable to supply original, colour scans will be required to electronically upload certified copies of their documents. Applicants can prepare these documents prior to the opening of applications. A full document checklist is available in the 2016 AGPT Applicant Guide (available on the AGPT website www.agpt.com.au in 2015).

REFEREES

All applicants must provide the details of two referees in their online application. Referees ideally should be medical practitioners who have directly supervised the applicant for at least a period of four weeks within the past three years. Applicants need to select referees who are able to confidently make judgements about the applicant’s professional capabilities and suitability for general practice, and who can be contacted during the selection period. Referees may be contacted by training providers for their reference during stage 3 of the selection process (see page 25).

SELECTING A TRAINING PROVIDER

Applicants are encouraged to contact the training providers of the regions in which they are interested in training, prior to applying, to assist them in determining where they would like to train (see list of training providers on page 17). Applicants should only consider regions they are willing to train in and, if necessary, relocate to. Please note: The list of training providers is current until 31 December 2015. A competitive tender process will be undertaken during 2015 for the delivery of the 2016 AGPT program and future cohorts. This will likely result in a smaller number of training providers; a possible change in regional footprints; and, possibly, new providers taking on delivery of the program. It is not anticipated the change in providers will impact training places.

Australian General Practice Training Handbook 2016

28 NATIONAL TESTING AND ASSESSMENT

Eligible applicants are required to undertake two assessments at two separate venues: The online Situational Judgement Test (SJT), which will be undertaken at National Testing Centres between 15 June and 6 July 2015 AND





Face-to-face Multiple Mini Interviews (MMIs), which will be undertaken at a National Assessment Centres between 26 June and 19 July 2015.

Both the National Testing Centres and National Assessment Centres will be held in most capital cities and some large regional centres. A full list of locations, dates and times will be available on the AGPT website (agpt.com.au) by 13 April 2015. What is an online Situational Judgement Test?

The online Situational Judgement Test (SJT) is an examination comprised of 50 multiple choice questions, which takes 120 minutes to complete including time for applicants to provide feedback. The SJT assesses an applicant’s:

Ability to reason in a clinical situation Analytical/problem solving skills • Professional/ethical attributes. The structure of the SJT: • •

• • •

Applicants are presented with a scenario based in a clinical context; a number of possible responses to the scenario are also presented Applicants are asked to either rank the responses in order of correctness, or select the most appropriate responses to the situation The SJT is then scored.

29 Example

Mrs Lee, a nurse, comes to see you for her flu vaccine. She asks you to write a script for the flu vaccine for her husband and says that she will give him the vaccination at home. Mrs Lee tells you that her husband has a regular doctor but he has been too busy to make an appointment to see him. Rank in order the following actions in response to this situation (First = Most appropriate; Last = Lease appropriate).

A. Explain that you are unable to write a prescription for Mr Lee B. Suggest that Mr Lee arranges an appointment with you C. Request that Mr Lee makes an appointment with his usual doctor D. Write the script for the flu vaccine as requested E. Contact Mr Lees’ doctor for advice as to whether this is appropriate Best Answer would be as follows: C. Request that Mr Lee makes an appointment with his usual doctor A. Explain that you are unable to write a prescription for Mr Lee B. Suggest that Mr Lee arranges an appointment with you E. Contact Mr Lees’ doctor for advice as to whether this is appropriate D. Write the script for the flu vaccine as requested Rationale for answer: (You will not be asked to explain your answer. This rationale is for information only.)

C is the best answer. This is the most appropriate response, as it is will provide the best care for the patient and would remove the need for you to provide a prescription. A is the next best answer. Whilst it is important that Mrs Lee understands that you are unable to write a prescription for Mr Lee, this does not completely address the situation which is her husband needing assessment regarding the need for a flu vaccination.

B is the next best answer. While it is a better option that Mr Jones has an appointment with you, rather than you providing the prescription for Mrs Lee to give the vaccination. Seeing the doctor who has cared for him in the past, is a better health care approach for Mr Lee. E is not a good response because you should be aware that it is inappropriate to provide a prescription for a patient that you have not seen. You should not need to seek this opinion from another doctor.

D is not a good response because it is inappropriate to provide a prescription for a patient that you have not seen and assessed and for the vaccination to be given to him by his wife. This is unprofessional behaviour and unsafe clinical practice.

Australian General Practice Training Handbook 2016

30 Example

You are looking after Mrs King, who is being investigated in hospital. You are asked by her family not to inform Mrs King if the results confirm cancer. Choose the three most appropriate actions to take in this situation.

A



B



C



D



E



F



G



H

Ignore the family’s wishes

Agree not to tell Mrs King

Explain to the family that it is Mrs King’ decision

Ask Mrs King whether she wishes to know the test results

Ask Mrs King whether she wishes you to inform the family

Inform Mrs King that her family do not wish her to have the results

Give the results to the family first

Give the results to the next of kin first

Best Answer would be selected as follows: A. Ignore the family’s wishes B. Agree not to tell Mrs King

✓ ✓ ✓

C. Explain to the family that it’s Mrs King’s decision D. Ask Mrs King whether she wishes to know the test results E. Ask Mrs King whether she wishes you to inform the family F. Inform Mrs King that her family do not wish her to have the results G. Give the results to the family first H. Give the results to the next of kin first

Rationale for answer: (You will not be asked to explain your answer. This rationale is for information only.)

As Mrs King is the patient it is her decision whether she should hear her results, not the family’s. Indeed, it is Mrs Kings’ choice whether the family should be informed of the results at all.

This should be explained to the family. Therefore the correct responses are C, D and E. Together these actions are the most appropriate response to the situation.

31 What are Multiple Mini Interviews?

Multiple Mini Interviews (MMIs) involve applicants being rotated between interview stations (one for each standard interview question) with each interviewer asking the same question to each applicant individually. Applicants will have two minutes to read the question before entering the interview room, then eight minutes to answer the question from the interviewer. The applicant is then rotated to the next interview station and the same process applies for the next question. Each interviewer gives the applicant a score out of seven based on standardised criteria. Example [This question looks at your analytical and problem solving skills]

“Please describe a time when you were faced with a challenging diagnostic problem. Why was it so challenging and how did you develop a management plan for the patient?” Further examples of MMI questions can be found on the AGPT website at www.agpt.com.au. PLEASE NOTE: Unlike objective structured clinical examinations (OSCEs), MMIs do not involve patient presentations.

Australian General Practice Training Handbook 2016

32

Diagram 4: General/Rural Pathway Eligibility Guide – AGPT 2016 The following flowchart can be used as a guide to determine if OTD and FGAMS applicants are subject to section 19AB of the Health Insurance Act 1973 (the Act). Applicants should identify which of the following two categories applies to them, and then follow the arrows to determine which pathway they are eligible to apply for.

1

2

You are a doctor who was trained overseas (but not in New Zealand).

You obtained your primary medical qualification in Australia/New Zealand whilst an international student.

By January 2016 will you have been medically registered in Australia for a period of 10 years or longer and currently hold Australian/New Zealand permanent residency or citizenship?

Were you an Australian/New Zealand citizen or permanent resident at the time you commenced your Australian/New Zealand medical degree? No

No

Yes

Were you assessed as eligible to sit the AMC examinations prior to 1 January 1997? Yes

It appears that you may not be subject to section 19AB of the Act (the 10-year moratorium) and should be able to apply for both general and rural pathway preferences.



Yes

By January 2016 will you have been medically registered in Australia for a period of 10 years or longer and currently hold Australian/NZ permanent residency or citizenship?

No

It appears that you may be subject to section 19AB of the Act (the 10-year moratorium) and may be restricted to the rural pathway.

?

Yes

It appears that you may not be subject to section19AB of the Act (the 10-year moratorium) and should be able to apply for both general and rural pathway preferences.



No

It appears that you may be subject to section 19AB of the Act (the 10-year moratorium) and may be restricted to the rural pathway.

?

Program Eligibility Guide - AGPT 2016 The flowchart below can be used to determine eligibility for the 2016 AGPT program Are you an Australian/New Zealand permanent resident or citizen, or will you be by 8 May 2015?

CITIZENSHIP

YES

NO

Are you a temporary resident who obtained your primary medical qualification in Australia/New Zealand and is currently applying, or intends to apply for, Australian/New Zealand permanent residence?

Did you obtain your primary medical qualification in Australia? YES

NO

NO

YES

x Did you obtain your primary medical qualification in New Zealand? YES

You are not eligible

NO

Are you an AMC graduate who has successfully completed all elements of the AMC?

PRIMARY MEDICAL QUALIFICATIONS

NO

YES

Will you have done so and received your AMC certificate by 8 May 2015?

Will you have received your AMC certificate by 8 May 2015? YES

NO

YES

x

Will you have completed the competent authority pathway via the AMC by 16 August 2015? YES

NO

You are not eligible

NO

?

Please contact the AGPT Selection team on 1800 DR AGPT (1800 37 2478)

MEDICAL REGISTRATION

Do you expect to have general medical registration without conditions or undertakings in Australia by the commencement of the 2016 training year (1 February 2016)? YES

NO

?

OTHER TRAINING PROGRAMS

Are you enrolled in any other specialist vocational training programs (including AGPT)? YES

Please contact the AGPT Selection team on 1800 DR AGPT (1800 37 2478)

NO

?

Please contact the AGPT Selection team on 1800 DR AGPT (1800 37 2478)

IT APPEARS YOU ARE ELIGIBLE

For more information

33

For detailed information about the 2016 AGPT program application and selection process, including the key dates, required documentation and examples of SJT and MMI scenarios visit the AGPT website at agpt.com.au and read the 2016 AGPT Applicant Guide or contact the AGPT Selection team.

The AGPT Selection team is responsible for managing the application and selection related processes for entry into the AGPT program. Contact information: AGPT Selection team Email: [email protected] Telephone: 1800 DR AGPT (1800 37 2478) or for international callers: +61 2 6289 2666 Website: agpt.com.au

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